Cardiovascular outcomes and mortality after

initiation of canagliflozin: Analyses from the

EASEL Study
Jacob A. Udell, Zhong Yuan, Patrick Ryan, Toni Rush, Nicholas M. Sicignano, Michael
Galitz, Norman Rosenthal

A JOURNAL CRITICAL APPRAISAL

MARK ALLAN REZAGA
GENERAL DATA

NAME: AM
AGE: 66
GENDER: FEMALE
STATUS: MARRIED
ADDRESS:BACOLOD CITY
CHIEF COMPLAINT: EXERTIONAL DYSPNEA
HISTORY OF PRESENT ILLNESS

1 month PTC – noted easy fatiguibility and exertional dyspnea, no

intervention done

2 weeks PTC – noted swelling of both feet, productive cough with greenish
sputum noted. Lipid profile, serum creatinine and chest xray was
requested.

1 week PTC – resolution of cough, persistence of exertional dyspnea.

Patient was noted to be hypertensive at 170/100 and was started on
Losartan 50mgtab BID and Furosemide 40mg/tab OD

On the day of consult noted brought in her X ray result which revealed
cardiomegaly. Exertional dyspnea lessened.
Past Medical History

 Patient is a known Diabetic for 5 years. Patient is taking Metformin

500mg/tab BID
 Non smoker, non alcoholic drinker
REVIEW OF SYSTEM

GENERAL: (-) weight loss (-) loss of appetite (-) fever (-) night sweat
EYES, EAR, NOSE, MOUTH & THROAT: (-) blurring of vision (-) redness (-)
hearing loss (-) ear pain (-)nosebleed (-) sore throat (-) facial pain or
numbness
RESPIRATORY: (-)SOB (-)DOB (-)cough (-) cold
CARDIOVASCULAR: (-) palpitation (-) chest pain (-) orthopnea (-)
syncope
GASTROINTESTINAL: (-) constipation (-) loose watery stool (-)abdominal
pain
GENITO-URINARY: (-)FREQUENCY (-) URGENCY (-) DYSURIA (-) POLYURIA
MUSCULOSKELETAL: (-) JOINT PAINS (-) BACK PAIN (-) SWELLING (-)
DEFORMITY
INTEGUMENTARY: (-) RASHES (-) SKN LESION
PHYSICAL EXAM

GENERAL: ambulatory, conscious, coherent not in distress

Vital Signs: BP: 130/80 PR: 69 RR: 18 T:37
HEENT: Anicteric Sclera, pink palpebral conjunctiva (-) nasoaural
discharge (-) cervical lymphadenopathy
CHEST AND LUNGS: Symmetrical chest expansion, clear breath sounds
(-) wheezes (-) rales
HEART: adynamic Precordium, normal rate regulare rhythm , (-)
murmur
ABDOMEN:Flat , soft, normoactive bowel sounds, nontender
EXTREMITIES: grossly normal extremities , full equal pulses(-) edema
PERSONAL SOCIAL HISTORY

NON SMOKER
NON ALCOHOLIC DRINKER
NO FOOD PREFERENCES
WORKS AS A NURSE
JOURNAL APPRAISAL
Cardiovascular outcomes and mortality
after initiation of canagliflozin: Analyses from
the EASEL Study
Jacob A. Udell, Zhong Yuan, Patrick Ryan, Toni Rush, Nicholas M. Sicignano, Michael
Galitz, Norman Rosenthal
Step 2.
Population: Newly diagnosed Type 2 Diabtes Mellitus patients
Intervention: canagliflozin
Comparison: non‐SGLT2 inhibitors
Outcome: all cause mortality and hospitalization with heart failure
Method: Retrospective New User Study
Clinical question:

Does the use of SGLT2 inhibitors reduce the risk of heart failure in DM
Patients.
Step3.
1.a Was the assignment of patients
to treatment randomized?
No
1.b Were the groups similar at the
start of the trial?
 Yes
4. Were all the participants who entered the
trial accounted for?

 Yes
5. Were measures objective ?

Yes
Will The result help me in caring for
my patient?
Yes No
Is my Patient so different ✔
from those in the study
that the result cannot
apply
Is the treatment feasible ✔
in my setting?
Will the potential benefits ✔
of treatment outweigh
the potential harms of
treatment for my patient